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Pathology of Desmoplastic

Spitz Nevus

Dr Sampurna Roy MD                


Dermatopathology Case 106

Diagnosis: Desmoplastic Spitz Nevus





Desmoplastic Spitz nevus (DSN) is a rare variant of spitzoid tumour which was first described by Reed et al. in 1975.

Desmoplastic Spitz nevus has clinical and histopathological features that are difficult to differentiate from dermatofibroma and desmoplastic malignant  melanoma (DMM), which requires aggressive therapy for cure.

It occurs most frequently in young adults and children.

Desmoplastic Spitz nevus usually presents as a red-brown papule or nodule, located on the extremities.

However, lesions on the abdomen, head and neck region and a case with multiple lesions have been reported. 


Microscopic features:


Desmoplastic Spitz nevus is characterized by dermal proliferation of large epithelioid and / or fusiform melanocytes within a desmoplastic stroma, comprising thick, eosinophilic collagen bundles. 


Differential diagnosis:

1)  Spitz nevus:  It is differentiated from classical variants of Spitz nevi by lack of dermoepidermal activity, absence of Kamino bodies, increased dermal collagen and presence of ganglion-like epithelioid cells.

2)  Dermatofibroma: The DSN can be mistaken for dermatofibroma due to similar location and clinical appearance.

It can be differentiated precisely from dermatofibroma with the presence of melanocytes and the positive immunohistochemical staining of the cells with S-100 protein and antibody HMB-45.

3)  Desmoplastic malignant melanoma:  From a histopathological point of view, symmetry, circumscription, melanocytic maturation and involvement  of adnexal structure are significantly more frequent in desmoplastic Spitz nevi.

The presence of melanocytic junctional nests associated with discohesive cells, variations in size and shape of the nests, lentiginous melanocytic proliferation, actinic elastosis, pagetoid spread, dermal mitosis, perineural involvement and brisk inflammatory infiltrate are significantly more frequent in desmoplastic melanoma.

No significant difference is found concerning epidermal hyperplasia, presence of Kamino bodies or moderate inflammatory infiltrate.

Read related post: Pathology of Spitz Nevus


Further reading:

Angiomatoid Spitz nevus: a distinct variant of desmoplastic Spitz nevus  with prominent vasculature

Desmoplastic (sclerotic) nevus: an underrecognized entity that resembles dermatofibroma and desmoplastic melanoma

Desmoplastic spitz nevus: report of a case and review of the literature.

Desmoplastic spitz naevus can be mistaken for desmoplastic malignant melanoma and dermatofibroma.

Desmoplastic Spitz nevus: a histopathological review and comparison with desmoplastic melanoma.

Desmoplastic nevus: An entity distinct from spitz nevus and blue nevus

p16 expression differentiates between desmoplastic Spitz nevus and desmoplastic melanoma.

DesmoplasticSpitz nevus showing vascular proliferation more prominently in the deep portion.

Fluorescence in situ hybridization as an ancillary method for the distinction of desmoplastic melanomas from sclerosing melanocytic nevi.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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